Introduction: Lobectomy with lymph node dissection is the gold standard treatment for stage IA–IIA Non-Small Cell Lung Cancer (NSCLC). Surgery is responsible for higher early mortality but offers better overall long-term survival. The patient population concerned is often elderly and combines the comorbidities of smoking and age. Several trials have shown good results of stereotactic radiotherapy (SABR) in terms of local control and tolerance in elderly subjects. Our objective is to study the survival and regional control of patients over 75 years treated by surgery or SABR for localized NSCLC. Materials and Method: We conducted a single-center retrospective study between January 2012 and December 2022 including elderly patients who received surgery or SABR for NSCLC less than 5 cm in size, N0, M0. A cumulative comorbidity index was calculated for each patient, considering severity and impact of treatment. We performed subgroup analyses using CART method to identify factors impacting survival and early death. Results: After propensity score matching, 127 operated patients were matched to 85 patients treated with SABR. Overall survival at 1 and 5 years for the operated patients was 83.87% and 47.30% compared with 88.8% and 31.5% in the radiotherapy group (p= 0.068). We have identified four factors influencing the incidence of early mortality: gender, World Health Organization Performance status (WHO status), Forced Expiratory Volume in 1 s (FEV1), and treatment group. Conclusions: Surgery seems to remain the standard of treatment in terms of overall survival and locoregional recurrence, in a context where SABR nevertheless provides excellent local control and tolerance in the short and long term. In order to improve patient selection, we are proposing for the first time a tool to aid therapeutic decision-making.
引言：肺叶切除联合淋巴结清扫是治疗IA-IIA期非小细胞肺癌（NSCLC）的金标准。手术虽导致较高的早期死亡率，但能提供更好的长期总生存率。相关患者群体多为老年人，常合并吸烟及年龄相关的并发症。多项试验显示立体定向放疗（SABR）在老年患者中具有良好的局部控制率和耐受性。本研究旨在探讨75岁以上局限性NSCLC患者接受手术或SABR治疗的生存率及区域控制情况。 材料与方法：我们于2012年1月至2022年12月开展单中心回顾性研究，纳入接受手术或SABR治疗、肿瘤直径小于5厘米的N0M0期NSCLC老年患者。通过计算累积合并症指数评估每位患者的并发症严重程度及对治疗的影响。采用CART方法进行亚组分析，以识别影响生存率和早期死亡的因素。 结果：经倾向评分匹配后，127例手术患者与85例SABR治疗患者完成匹配。手术组1年及5年总生存率分别为83.87%和47.30%，放疗组分别为88.8%和31.5%（p=0.068）。研究确定了影响早期死亡率的四个因素：性别、世界卫生组织体能状态评分、第一秒用力呼气容积以及治疗分组。 结论：尽管SABR在短期和长期均展现出优异的局部控制率和耐受性，但从总生存率和局部区域复发率来看，手术似乎仍是标准治疗方案。为优化患者选择，我们首次提出一种辅助治疗决策的工具。
Surgery Versus Stereotactic Radiotherapy in Patients over 75 Years Treated for Stage IA–IIA NSCLC
肿瘤(癌症)患者之家